Summary:In patients receiving long-term therapeutic or replacement corticosteroids, delayed or inappropriate adjustment of steroid dosage during intercurrent illness may be fatal. We used a questionnaire to assess current levels of patient knowledge, awareness of the need for action during intercurrent illness and the frequency with which steroid warning cards and Medic Alert pendants were carried, in 61 patients on long-term replacement corticosteroids and in 40 patients receiving long-term therapeutic corticosteroids.Only 67 ofthe 101 patients taking corticosteroids were carrying a steroid warning card. Eleven ofthe 21 Medic Alert owners wore their pendants. Only 18 of the 41 patients in the therapeutic group and 41 of the 60 patients in the replacement group would take appropriate action during an intercurrent illness (P< 0.001).

The number of Pap tests from high-risk patients should be maximized in prospective and retrospective rescreening. Unsatisfactory Pap tests should also be included. All readily identifiable high-risk human papillomavirus-positive cases with an interpretation of negative for intraepithelial lesion or malignancy should be prospectively rescreened. Cervical biopsy results with high-grade cervical intraepithelial neoplasia or worse (CIN 2+) should trigger retrospective rescreening. Regular feedback should be provided to cytotechnologists and cytopathologists. Upgraded diagnoses from negative for intraepithelial lesion or malignancy to atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, should be monitored.